WhiteCoat

WTF Moment #897

Nurse [as she was walking out of the Dirty Utility room]: “Where’s the timer for the pregnancy tests?”
Secretary: “Oh, the lady from lab threw it out. It was expired.”
Nurse: “Wait. She came to our department and threw something in our department out? And she said that the timer expired?”
Secretary: “Yeah. She said that it could be a JCAHO violation if we were using an expired timer.”
Nurse: “It’s a f**king clock. How does a clock expire?”
Secretary: “Ask the ‘Lab Nazi.'”

We have to keep a timer in the Dirty Utility Room (which happens to be one of the many ROOMS in the emergency DEPARTMENT) so that pregnancy tests are read at precisely 3 minutes. If they are not read at 3 minutes, that could be a JCAHO violation because patient safety could suffer.

Now companies are apparently putting expiration dates on electronic equipment to assure patient safety. If electronic equipment is used past its expiration date, that could be a JCAHO violation.

They still haven’t replaced the timer in the Dirty Utility Room, so we’re officially screwed if the hospital gets inspected, but I also can’t verify whether these damn things have expiration dates on them. I need to know if anyone else out there has electronic equipment with expiration dates on it in the hospital. If so, please send me pictures. If anyone has any kind of proof about expiration of hospital electronics, I’d also appreciate it if you’d send me a copy so I can post it.

I am getting to the point that I want to become a JCAHO inspector just to mess with people’s heads. Imagine how much fun it would be to look at a chair, point at it, say it is expired, and then get 5 college graduates with advanced degrees to trip over each other in order to get rid of the chair. There’s probably some JCAHO internal message board somewhere with a Top 10 list of dumb things that surveyors got hospital admins to do.

All you medical supply companies – take note. You can increase your profits exponentially by putting an expiration date on all your equipment. Medical computers expire in 3 years. TVs used in hospitals expire in 2 years. Construction companies – chisel an expiration date in the hospitals you build. Ten years ought to do it.

Who gets to make up the rules that JCAHO follows, anyway?

26 Responses to “WTF Moment #897”

  1. rlbates says:

    Definitely a WTF moment! How does a clock expire?

  2. [...] This post was mentioned on Twitter by rlbates. rlbates said: From WhiteCoat's Call Room >> WTF Moment #897 http://bit.ly/bD3vRg [...]

  3. Matt says:

    … Sigh. Once more we see how JCAHO is a solution in search of a problem.

  4. Sevesteen says:

    Industry has been dealing with similar issues with the advent of ISO 9000 quality standards, which among other things sets standards for measurements. In industry, if you are measuring something and making quality judgement, your tools have to be traceable back to an official standard measurement, and periodically checked to make sure they remain accurate.

    Mostly this makes sense. It gets silly when your measurements are very coarse in relationship to the accuracy of the tool. I’m guessing that you are talking 3 minutes plus or minus 10 seconds or more–Although a clock can drift, it is virtually impossible for a modern clock to drift that far, as 10 seconds per DAY would be a huge error.

    So I had to calibrate things like plastic rulers and wind-up kitchen timers… There were some items where it made more sense for us to buy pre-calibrated, and throw them away when the calibration expired–the cost of certifying or re-certifying them exceeded the cost of a new one.

  5. Ed says:

    Was it an expiration for the batteries maybe…..?

  6. ThorMD says:

    Last month I had to be trained how to use pH paper. Cause dipping it and then checking the color is so complicated that I might do it wrong, despite my 15 years experience. I’m so glad I had the lesson though, because now I can apply the knowledge to check the chlorine and pH in my pool and hot tub.

    • CJ says:

      In one of the hospitals I work at, the nurses on the floor no longer perform bedside heme-occult testing. Apparently there is some kind of training required if you’re going to “perform” these tests, and I guess the nurse managers decided it was too much of a hassle to make sure that everyone was properly certified, so now they just won’t do it.

      For those who are unaware, a bedside heme-occult test requires you to take a small stool sample, wipe it on a special piece of cardboard, and then drip one drop of special liquid on the card. If it changes colors, it’s positive.

      I don’t know what kind of extensive training there is for that test (I know I never received it…), but it seems kind of silly to me.

      • Dr. S says:

        It apparently isn’t as easy as you might think. Our nurses were developing their Hemoccult cards with Gastroccult developer. It’s not the same thing.

        And, for that matter, the regulatory agencies figured out that nurses weren’t doing “simple” things like this correctly (see above) and started requiring the people doing them to be trained and to have that training documented.

  7. (Gleefully Former) Lab Tech says:

    Seconding Sevesteen here. I used to be a lab tech and even the kitchen timers we used to time the slide-staining had to be periodically re-calibrated. So, while the timer itself might not expire it might require recalibration. We had to have our one super-accurate mercury thermometer (the one we used only once a year to check the calibration of all other thermometers) calibrated once a year. Hmmm, calibrated once a year and USED once a year…

    Now you understand my glee at switching careers. I’m only hopping PT will be a better career as I don’t think there is a way to calibrate reflex hammers (yet).

  8. ZMD says:

    In our operating room, JCAHO, or The Joint Commission (I get a grin every time I hear that), has mandated that the disposal of syringes should be a two step process. The needle goes into a red box while the syringe and any leftover drug be disposed in an identical but white box. Thus the simple act of throwing away a syringe that used to require two seconds now requires handling a dirty needle with both hands and multiple processes. Our OR even have people going into the rooms to look into the white boxes to make sure there are no sharps inside. I guess The Joint Commission (ha ha) figures patient safety takes precedence over healthcare worker safety.

  9. igloodoc says:

    I used to wonder how there could be a nation wide shortage of Lasix. I don’t wonder any more…

  10. k says:

    You’ve never heard of the Sony timer? Sonh products inevitably fail within a week of warranty expiration.

  11. a generic doc says:

    We’re now in a world where doctor’s board certifications expire in just a few years. So, it shouldn’t be surprising that just about everything in a hospital would have an expiration date.

    Unfortunately, the only thing that doesn’t have an expiration date is JACHO!

  12. paul says:

    a couple of days ago i had a crash intubation and the airway equipment that was hanging on the wall of the resuscitation room was all taken down and missing. then began a frantic search thru all the drawers in the room for the equipment. we ultimately found everything and got the patient tubed, but when we debriefed i was furious and nobody could tell me why the equipment was all hidden.

    turns out we had a mock jcaho inspection the preceding week and the hanging equipment on the wall was some kind of infection control violation.

    so… safety first? or your own perpetual existence first, jcaho?

  13. SeaSpray says:

    Funny Post ..but frustrating for you.

    You should infiltrate JCAHO to mess with *their* heads ..somehow.

  14. ChuckInMI says:

    Who started JCAHO anyway? Was it started during the Clinton years?

    • Brighid says:

      Nay, I worked for Blue Cross Blue Shield in the ’70s and it had been around quite a while before then.

  15. Nurse K says:

    I’m one of the policy Nazis for my ER, and I’ve read policies related to disinfecting things (which requires a timer), and there’s nothing in there about timer expirations.

    Here’s a secret. Next time you or someone goes to Wal-Mart, go pick up a timer and get reimbursed for it. Solve the problem, medical director-type guy.

    Guess who does that for my dept? That would be me and my boss. Would be nice if medical leadership hauled their butts to Wal-Mart on their day off to buy junk for the ER (wink, wink, nudge, nudge).

  16. Anonymous says:

    Well in some of our research labs we have equipment (oscilloscopes, weights, microscopes, strain testers, etc etc) that is “due” for calibration every year (less/more depending on sensitivity). So technically some of our stuff would be “expired” if it wasn’t calibrated. After all the “wtf” moments of college labs, now I get warm feelings when I know the crap I’m working with is actually accurate.

    @NurseK. Uh no. I’d rather fill out a purchasing form,submit it to one of our purchasers for online ordering and have them bill it directly to the department expense account. It’s way easier than going to radioshack, paying out of pocket, and waiting weeks for a reimbursement.

    • Nurse K says:

      I’m just telling WC how to solve the problem. $8 and a form makes the problem go away. If you’d rather wait until the purchasing person comes back from vacation, sift through 200+ medical supply catalogs until you find one, order it, and wait 7 days for it to arrival, that’s your choice. Meanwhile, JCAHO or the health dept shows up and cites you for not timing the tests, and you have hours more of work explaining yourself to directors et al. Research labs aren’t really doing tests that need to be done NOW in an ER, so maybe you can afford to take the week off until your $8 timer essential to do one of your quality controls arrives in the mail.

      It’s no different than teachers buying magic markers and glue for their classroom and getting reimbursed.

  17. Derrick says:

    My least favorite rule (if it is even a rule) is the one that says no coffee at nurses stations. If I have to be awake for 30 hours working, I want coffee… where I am working… without having to leave the unit and walk over to an approved area off the unit to drink my beverage.

  18. ladyk73 says:

    It starts with the dimwit manager who discovers some “expired timer,” and removes it without replacing it with something else….

    I used to be an accountant (for federally funded non-profits) who would have to present all of my work to a third person accounting firm. I would have hell for week/ month, while they tried to find something wrong….When the CPAs find a mistake, it justifies their very existance…

    When I have seen agencies who really had accounting disasters, the third party auditors would love it because they had the ability to charge the agency lots of money to fix it.

    I have had multiple “perfect” audits. In which
    the CPAS could find nothing wrong. However…they would then creat these “problems” in which the agency had too big/ too small line of credit, or that we should buy a better depreciation program…

    If Accounting audits are anything like a Joint Commission audit… you need the non-compliant timers in the hospital. It shows those “3rd party auditors” that your agency is well run enough to understand that having a properly calibrated radiology equipment is much more important than a freaking egg timer…

    Sort of like the accounting clean ups I have done. “So why did this expense go to misc?” “Oh…that $6.00 charge? Yeah, it would cost the agency $50 in my pay to find it…so yeah..I put it there, and moved on”

    I am babbling now…sorry

  19. Don Salva says:

    Expiration date on a clock. Wow that must be the fail of the century.

  20. Marilyn says:

    Ahh, the blessings of bureaucracy…

  21. @ladyk73 In the construction industry they call these helicopters, you need helicopters to be shot down. It’s one of the “games” that need to be played in a work environment, if you don’t play, you lose, and you end up losing a lot more than your time.

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